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Individual
DR. JOHNNY DWAYNE SMITH
Active
Individual
DR. JOHNNY DWAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1672
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721765
MOUNTAIN STATE BCBS
WV
01
—
001721766
BCBS
WV
05
—
3810001252
—
WV
01
—
P00154078
RAILROAD MEDICARE
WV
01
—
WV01672
HEALTH PLAN
WV
Enumeration date
07/19/2006
Last updated
10/27/2014
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